A Missing Link: Rehabilitation Counseling for Persons with Cancer

Estimate of relative five-year survival for persons diagnosed with cancer in 1990 is at fifty percent (American Cancer Society, 1990). Despite these encouraging statistics, job discrimination and associated employment problems continue to plague cancer survivors. The purpose of this paper is to provide a review of the literature and recommend the inclusion of rehabilitation counselors as an integral part of the multidisciplinary oncology team. A rationale for linking hospital and community based support services is presented.

Vocational rehabilitation has been willing to address the most pressing needs of people with disabilities in our society. Needs addressed have been as diverse as severe mental retardation, traumatic brain injury, and other developmental disabilities such as cerebral palsy. However, one disability group that apparently has been neglected in the rehabilitation process has been individuals with cancer (Goldberg & Habeck, 1982). Cancer has been designated by the Vocational Rehabilitation Act of 1973 as a disease resulting in severe disability requiring priority services. However, despite this legislative mandate, Goldberg and Habeck found that persons with cancer accounted for only 0.6% of the total successful vocational rehabilitation closures in 1979.

Cancer is a complex group of debilitating diseases resulting from the uncontrolled growth of abnormal cells (American Cancer Society, 1990). Cancer cells may originate in any organ system of the body. The presentation and course of the disease varies with diagnosis of cell type and response to the disease is highly individual. Despite the apparent extreme consequences of cancer, estimates of the relative five-year survival in the U.S. for all types of cancer will be approximately 50% in 1990. That means over 500,000 persons could potentially benefit from vocational rehabilitation services in one year. Unfortunately, few people with cancer have received these services (Goldberg & Habeck, 1982).

It is unclear why people with cancer have not received the benefit of vocational rehabilitation at the same rate experienced by other disability groups. However, three explanations have been postulated. First, it may be that many vocational rehabilitation counselors believe the prognosis for people with cancer is so poor that the time and expense involved in providing services precludes the benefits to be gained (Conti, 1990).

Second, Watson (1983) suggested that job discrimination may exist for those people with cancer who wish to attain or maintain employment after being diagnosed. Employers may not wish to hire an individual on the assumption that the employee will miss large periods of work due to illness, or that the employee will die on the job. Clearly if this is the case, successful rehabilitation will require extreme effort on the part of the counselor to identify employers willing to hire a person with a diagnosis of cancer. These efforts may not appear cost effective. Indeed, this attitude may be reinforced by health providers (e.g., physicians and nurses) who view cancer as a terminal disease, resulting in a low inclusion rate into the rehabilitation system for people with cancer. The medical model of providing health services typically does not take a proactive concern for the employment of those individuals receiving treatment. Discharge planning and case management are seldom utilized to address employment as a viable outcome for the person with cancer leaving the hospital. Furthermore, families and friends, sources for many vocational rehabilitation referrals (Keitel, Cramer, & Zevon, 1990) may be cued by health providers and view cancer as a terminal disease. Thus, a subtle form of employment discrimination occurs when the person with cancer is seen as an invalid by family, friends, and health providers rather than as a potential contributing member of the work force.

Finally, the person with cancer may experience what Mundy and Moore (1990) identify as "disability syndrome. …

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